Ability of dipyridamole-thallium-201 imaging one to four days after acute myocardial infarction to predict in-hospital and late recurrent myocardial ischemic events.
The ability of dipyridamole-thallium-201 imaging to predict in-hospital and late cardiac events when performed very early (62 +/- 21 hours, range 23 to 102) after acute myocardial infarction (AMI) was tested in 50 patients. During hospitalization, 1 patient developed recurrent AMI and 8 patients developed recurrent angina after MI associated with ST-segment depression at 60 +/- 42 hours after the dipyridamole-thallium-201 imaging; of these, 6 required urgent coronary revascularization. No patient died in-hospital. There were no serious adverse effects during the dipyridamole protocol. Using stepwise multivariate logistic regression analysis, the best and only statistically significant predictor of in-hospital ischemic cardiac events was the presence of thallium-201 redistribution within the infarct zone (p = 0.0001). Of 20 patients with infarct zone thallium-201 redistribution, 9 (45%) developed in-hospital ischemic cardiac events compared to 0 of 30 patients without infarct zone thallium-201 redistribution (p less than 0.0001). During a follow-up 12 +/- 7 months after discharge, 3 additional patients with infarct zone thallium-201 redistribution developed recurrent AMI or unstable angina, whereas no patient without infarct zone thallium-201 redistribution developed ischemic cardiac events. These data suggest that dipyridamole-thallium-201 imaging performed very early after AMI may identify a subgroup of patients at high risk for in-hospital and late ischemic cardiac events. Such patients may benefit from early cardiac catheterization and revascularization. Patients without infarct zone thallium-201 redistribution appear to be at very low risk for in-hospital and late ischemic cardiac events and may be candidates for early discharge.
Brown
K A
KA
Department of Medicine, University of Vermont College of Medicine, Burlington.
O'Meara
J
J
Chambers
C E
CE
Plante
D A
DA
D003327:Coronary Disease / Q000503:physiopathology; D004176:Dipyridamole / Q000009:adverse effects; D004562:Electrocardiography; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012008:Recurrence; D013794:Thallium Radioisotopes; D013997:Time Factors
D013794:Thallium Radioisotopes; D004176:Dipyridamole